Clinical Pearls, 23-Jan-1998. People are walking less and less. A report this week in the British Medical Journal estimated that people are walking 22% less today than they did in 1972. The greatest decline in walking was among 5 to 15 year olds. Thought to be primarily responsible for this decline is the rising use of the automobile. The report estimated that one fourth of all car trips are less than 2 miles. Also, since 1975 the percent of children travelling to school by car has increased from 12% to 23% in 1994. No amount of money devoted to medical care will make up for the decline in activity by our youth.

This week the Lancet reports on a patient with intractable hiccups that apparently was cured by smoking marijuana.

About 1 in 20 Americans have asthma, with about 1 in 10 children suffering from it; the good news it that a SINGLE daily dose of inhaled steroids can control symptoms (I.e. 4 puffs once a day is as effective as 1 puff 4 times a day). J Allergy Clin Immunol 1997 100:0771.

The combination of aspirin and coumadin (mean INR 1.47, mean dose 4 mg/d) was successful in preventing a heart attack in 5,085 men. Treating 1,000 men with aspirin OR warfarin a year would save 3 deaths; if both used for a year, 5 deaths avoided. Lancet 1998 351:0233.

The International Study of Infarct Survival (isis 3) concluded that contrary to earlier reports, sex has a minimal effect upon outcome after a heart attack. Age and other confounding factors are much, much more important. NEJM 1998 338:0008.

It is advocated the the use of bisphosphonates for the treatment of osteoporosis be restricted to 80 year olds with at least one spinal compression fracture and also a low bone mineral density. Arch Intern Med 1997 157:2617.

Treating chronic anal fissures with botulinum toxin was found to be more effective than saline injections in this study of 30 patients. Maria G … NEJM 1998 338:0217.

Aspirin is as effective as cholesterol lowering medications in the primary prevention of a myocardial infarction. Lancet 1998 351(9098).

In Kentucky, 60% of medicaid patients with an upper respiratory infection were given antibiotics although only an estimated 6% actually needed them. The cost savings for unnecessary antibiotic prescriptions in Kentucy is $1.62 million dollars a year. Mainous AG … Arch Fam Med 1998 007:0045.

Be careful about reading health books. You may die of a misprint. - Mark Twain (1835 - 1910)

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